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A Thoughtful Article on the Radical Changes Pending in Medical Education

Writing in JAMA, Ezekiel Emanuel outlines some of the radical changes that are imminent in medical education.[1] While medical practice is a craft that has to be taught in the context of clinical care, this is not the case for preclinical education. It is here that the most radical change will be felt. Forget problem-based learning, peer education, interactive classrooms, and the like. Academic staff are simply not needed to teach physiology, anatomy and pathology. So long academic staff! Forget the notion of a classroom, group tutorials, or anything of the sort. Students will learn from massive open online courses (MOOCs). And there is no reason that these courses should come from any particular medical college or university; simply download the online courses from the world’s greatest teachers. Students will be autodidacts. If some are temperamentally unsuited for self-education? Well then, they are probably not the right people for a medical career, given that being a doctor entails a lifetime of learning.

By and large, I agree with this analysis. But my worry is this – learning material is one thing, but acquiring the skills to organise complex information and present it in a coherent way, is another. While simply understanding and knowing the physiology is quite didactic, medical ethics is a different matter altogether. It is more a way of thinking and applying basic and often conflicting principles to complex decisions. Let me take another academic subject, history. Why study history at university? If you want to know about the Tudors, then look it up. But an employer hiring a history graduate will not be interested in a potential employee’s knowledge of the Tudors. Wise employers hire history graduates, not because of their knowledge of history, but because they are good at organising complex and contradictory information and producing a coherent and readable account of the material. This is the skill that a good history graduate acquires. And this skill comes not from reading, but from writing, coupled with critical appraisal of what has been written. It is through this process of writing and feedback that students will acquire valuable skills for the knowledge economy.

This takes me back to medical education. There is something wrong with the idea that it should consist of only two of Ezekiel’s phases: self-learning of the pre-clinical syllabus, followed by craft training at the ‘bedside’. I suggest that there is something that should come in between; where the student learns how to organise material and write well. Granted, they should have picked something of this up at school. However, they need to go beyond this. Thus, there should be modules somewhere in the course where they learn these analytical and writing skills. I think this could be taught in the contexts of clinical epidemiology, ethics, and of psychology and communication. And it should be taught by doctors not statisticians, philosophers and psychologists; their job is to mentor the doctors who educate the students, as I have argued before in this News Blog.[2, 3]

A rounded doctor needs three competency areas: a good understanding of preclinical subjects, good clinical analytical skills, and general skills in analysis of complex information.

Richard Lilford, ARC WM Director


  1. Emanuel EJ. The Inevitable Reimagining of Medical Education. JAMA. 2020.
  2. Lilford RJ. The Future of Medicine. NIHR CLAHRC West Midlands News Blog. 23 October 2015.
  3. Lilford RJ. Two Ideas of What it is to be a Doctor. NIHR CLAHRC West Midlands News Blog. 14 August 2015.
Fri 27 Mar 2020, 14:00 | Tags: Education, Richard Lilford